Resuscitation
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Comparative Study Observational Study
Increased survival from out-of-hospital cardiac arrest when off duty medically educated personnel perform CPR compared with laymen.
Bystander cardiopulmonary resuscitation (CPR) has been proved to save lives; however, whether survival is affected by the training level of the bystander is not fully described. ⋯ In cases of OHCA, medically educated bystanders initiated CPR earlier and an increased 30-day survival was found compared with laymen bystanders. These results support the need to improve the education programme for laypeople.
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Observational Study
Community socioeconomic status and public access defibrillators: A multilevel analysis.
Although current guidelines recommend that distribution of public-access defibrillators (PADs) should take into account area-level risk of out-of-hospital cardiac arrest (OHCA), community socioeconomic status (SES) can unduly influence policy implementation in positioning PADs. Using recent, complete data from Seoul Metropolitan City, Korea, this study aims to examine whether community SES is associated with distribution of PADs, in terms of per capita count and risk-grid coverage. ⋯ More affluent neighborhoods in Seoul exhibit higher per capita PADs, even accounting for OHCA risk, while risk-grid coverage is generally low regardless of community SES. Seoul's ongoing program aimed to increase PAD coverage should also pay attention to improving community-level inequality as well as distributional efficiency.
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Observational Study
The relationship between chronic health conditions and outcome following out-of-hospital ventricular fibrillation cardiac arrest.
The cumulative burden of chronic health conditions could contribute to out-of-hospital cardiac arrest (OHCA) physiology and response to attempted resuscitation. Yet little is known about how chronic health conditions influence prognosis. We evaluated the relationship between cumulative comorbidity and outcome following ventricular fibrillation OHCA using 3 different scales. ⋯ Based on these results, cumulative comorbidity can help explain survival variability and improve prognostic accuracy. Whether information about cumulative comorbidity or specific health conditions can inform resuscitation care is unknown though the results suggest comorbidity may influence acute pathophysiology and treatment response.
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Few data are available on the use of brainstem auditory evoked potentials (BAEPs) in combination with other electrophysiological tools to assess prognosis of comatose survivors from cardiac arrest (CA). ⋯ In this series of patients after CA, at least one of the BAEP waves was absent bilaterally in half the survivors; however, their use for prediction of poor neurological outcome remains limited.
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Mortality from out-of-hospital cardiac arrest (OHCA) is characterized by substantial regional variation. The Institute of Medicine (IOM) recently recommended enhancing the capabilities of EMS systems to improve outcome. In this study, we analyzed the trend in outcome from ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) OHCA in Rochester, MN. Survival from these forms of arrest is commonly employed as a benchmark of Emergency Medical Services (EMS) system performance. ⋯ We observed a significant improving secular trend in neurologically intact survival from VF/pVT cardiac arrests with a relatively high recent survival rate in this EMS System.